Heart rate variability in type 2 diabetes mellitus : A systematic review and meta-analysis

Journal article


Benichou, Thomas, Pereira, Bruno, Mermillod, Martial, Tauveron, Igor, Pfabigan, Daniela, Maqdasy, Salwan and Dutheil, Frédéric. (2018) Heart rate variability in type 2 diabetes mellitus : A systematic review and meta-analysis. PLoS ONE. 13(4), p. e0195166. https://doi.org/10.1371/journal.pone.0195166
AuthorsBenichou, Thomas, Pereira, Bruno, Mermillod, Martial, Tauveron, Igor, Pfabigan, Daniela, Maqdasy, Salwan and Dutheil, Frédéric
Abstract

Background
Cardiac autonomic neuropathy in type 2 dibetes mellitus (T2DM) patients is frequent and associated with high cardiovascular mortality. Heart rate variability (HRV) is the gold standard to measure cardiac autonomic neuropathy. We aimed to conduct a systematic review and meta–analysis to evaluate the impact of T2DM on HRV parameters.

Methods
The PubMed, Cochrane Library, Embase and Science Direct databases were searched on 1st October 2017 using the keywords “diabetes” AND (“heart rate variability” OR “HRV”). Included articles had to report HRV parameters in T2DM patients and healthy controls measured during 24 hours with a Holter–electrocardiogram. Measurements of HRV retieved were: RR–intervals (or Normal to Normal intervals—NN), standard deviation of RR intervals (SDNN), percetange of adjacent NN intervals differing by more than 50 milliseconds (pNN50), square root of the mean squared difference of successive RR intervals (RMSSD), total power, Low Frequency (LF), High Frequency (HF) and LF/HF ratio, as per Task Force recommendations.

Results
We included twenty-five case-control studies with 2,932 patients: 1,356 with T2DM and 1,576 healthy controls. T2DM patients had significantly (P<0.01) lower RR–intervals (effect size = –0.61; 95%CI –1.21 to –0.01), lower SDNN (–0.65; –0.83 to –0.47), lower RMSSD (–0.92; –1.37 to –0.47), lower pNN50 (–0.46; –0.84 to –0.09), lower total power (–1.52; –2.13 to –0.91), lower LF (–1.08; –1.46 to –0.69]), and lower HF (–0.79; –1.09 to –0.50). LF/HF did not differ between groups. Levels of blood glucose and HbA1c were associated with several HRV parameters, as well as Time from diagnosis of T2DM

Conclusions
T2DM was associated with an overall decrease in the HRV of T2DM patients. Both sympathetic and parasympathetic activity were decreased, which can be explained by the deleterious effects of altered glucose metabolism on HRV, leading to cardiac autonomic neuropathy.

Year2018
JournalPLoS ONE
Journal citation13 (4), p. e0195166
PublisherPublic Library of Science
ISSN1932-6203
Digital Object Identifier (DOI)https://doi.org/10.1371/journal.pone.0195166
Scopus EID2-s2.0-85044871320
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range1-19
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online02 Apr 2018
Publication process dates
Deposited02 Jun 2021
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Dutheil, Frederic, Trousselard, Marion, Perrier, Christophe, Lac, Gerard, Chamoux, Alain, Duclos, Martine, Naughton, Geraldine, Mnatzaganian, George and Schmidt, Jeannot. (2013) Urinary Interleukin-8 is a biomarker of stress in emergency physicians, especially with advancing age: The JOBSTRESS* randomized trial. PLoS ONE. 8(8), pp. 1 - 7. https://doi.org/10.1371/journal.pone.0071658
Different modalities of exercise to reduce visceral fat mass and cardiovascular risk in metabolic syndrome : the RESOLVE* randomized trial
Dutheil, Frederic, Lac, Gerard, Lesourd, Bruno, Chapier, Robert, Walther, Guillaume, Vinet, Agnes, Sapin, Vincent, Verney, Julien, Ouchchane, Lemlih and Duclos, Martine. (2013) Different modalities of exercise to reduce visceral fat mass and cardiovascular risk in metabolic syndrome : the RESOLVE* randomized trial. International Journal of Cardiology. https://doi.org/10.1016/j.ijcard.2013.05.012
The long-term effects of occupational exposure to vinyl chloride monomer on microcirculation : a cross-sectional study 15 years after retirement
Lopez, Vincent, Chamoux, Alain, Tempier, Marion, Thiel, Helene, Ughetto, Sylvie, Trousselard, Marion, Naughton, Geraldine and Dutheil, Frederic. (2013) The long-term effects of occupational exposure to vinyl chloride monomer on microcirculation : a cross-sectional study 15 years after retirement. BMJ Open. https://doi.org/10.1136/bmjopen-2013-002785
Treatment of Metabolic syndrome by combination of physical activity and diet needs an optimal protein intake: a randomized controlled trial
Dutheil, Frederic, Lac, Gerard, Courteix, Daniel, Dore, Eric, Chapier, Robert, Roszyk, Laurence, Sapin, Vincent and Lesourd, Bruno. (2012) Treatment of Metabolic syndrome by combination of physical activity and diet needs an optimal protein intake: a randomized controlled trial. Nutrition Journal. 11(1). https://doi.org/10.1186/1475-2891-11-72